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As Pakistan’s population time bomb ticks, contraceptive pills for men might become a game-changer. DESIGN: SAMRA AAMIR

KARACHI:

With the world’s sixth largest population, and growing faster than the top five, Pakistan needs to drastically rethink contraception and family planning.

Until now, conception has largely been a man’s decision in a patriarchal society like Pakistan’s, but usage of contraceptives, when allowed by men, has largely been a woman’s responsibility.

That dynamic, however, may soon be turned on its head by the advent of the ‘male pill.’

The ticking bomb

The country’s headcount ticked past 180 million on World Population Day, July 11, 2012, according to the Population Census Organisation of the Government of Pakistan, and is expected to reach 300 million by 2050.

Fertility rates have been halved to 3.42 births per woman, from historic highs of 6.6 all the way up to the mid 1970s, but contraception usage is restricted.

Only 30% of married Pakistani women, however, use any form of contraception, according to the Pakistan Demographic and Health Survey, 2007. The percentage of men who use contraceptives is much lower.

That may simply be because of the variety of contraceptive options available to women – from pills and coils to injectables and rings – compared to only one accessible option for men, condoms. Even for that there is a lot of resistance. Vasectomy, for its invasiveness and non-reversibility, is not a popular option. In Pakistan, attitudes are also influenced by Islamic teachings that discourage permanent methods of contraception.

“According to Shariah [law] contraception is allowed if there is a genuine reason. But the methods allowed should be temporary and reversible and should not harm the user’s health. The reason should not be ‘who will feed them’,” said Mufti Shah Tafazzul Ali of Darul-uloom Karachi.

A contraceptive for men that is safe, non-invasive and with reversible effects may sound too good to be true, but is already in the making.

Herbal pill

While both allopathic and herbal versions of an oral male contraceptive are currently under research, the closest to hit the shelves is the pill from Indonesia.

Made from the shrub justicia gendarussa, which is found mostly in the Papua Island, the pill “disturbs the enzyme system of spermatozoa and affects its function,” according to Professor Bambang Prajogo, who started research on the world’s first non-hormonal contraceptive pill for males in 1987 at the Airlangga University in Surabaya, Indonesia.

In simpler words, the active ingredient from the herb weakens the sperm, disabling it from penetrating an ovum. The pill’s effect, meanwhile, is not permanent. According to findings of Dr Dyan Pramesti from Airlangga University, who held clinical trials, men were fertile again just two months after they stopped taking the pill.

The pill has been tested on mice for years, and has shown to be safe, effective and with few side effects, Professor Prajogo had said in an interview to PBS in July 2011. Clinical trials on humans had already started by then and, according to Prajogo, had shown “impressive results.”

The Gendarussa pill is ready to hit the Indonesian market in 2013, but will have to be approved by the World Health Organisation before it will be widely available elsewhere. Right now, a small-scale herbal medicine company called Naturoz has started the pill’s production. Once approved by international health authorities, it can easily be exported to Pakistan.

Under research

The latest news of an allopathic male pill has come out of Baylor College of Medicine in Houston, Texas.

Researchers discovered a compound, JQ1, that produces a rapid and reversible decrease in sperm count in mice.

According to a report from August 2012, the compound penetrates a boundary in the cells of the male testes and shuts off sperm development. The result is non-hormonal birth control that researchers said is entirely reversible. The research, however, is preliminary and clinical trials have yet to begin.

Revolutionising family planning

The idea of a male pill is being hailed by women’s groups, receptive males, and family planning advocates. The male pill would not only broaden the choice in contraceptives, but also change social attitudes towards family planning.

“Men being supportive, and involved in the choice, of a contraceptive method is the way forward. It would signal a behavioural change as currently men are generally a barrier to family planning,” said Dr Rehana Ahmed, a director at Greenstar Social Marketing, Pakistan and senior international health adviser to several NGOs.